We conducted a systematic review to synthesise current observational evidence on how physical activity, dietary behaviours, and sedentary behaviours cluster or co-exist in 5 to 24-year-olds. We also investigated the socio-demographic factors related to clusters, and both physical and mental health outcomes of different types of combinations of behaviours.

Our review of forty-nine cross-sectional and four prospective cohort studies, involving 778,415 participants from eighteen countries, revealed 172 clusters of diet, physical activity, and sedentary behaviour, categorised as healthy, unhealthy, or mixed. Mixed clusters were common (n=98), with distinct gender differences. Unhealthy clusters were prevalent among lower socioeconomic status individuals, associated with poorer physical and mental health compared to those with healthy clusters.

The complex nature of these findings shows the need for further research examining the sociodemographic factors that influence different clusters of behaviours and how such clusters influence health. More longitudinal studies and those including young adults are needed as much of the current evidence is based on cross-sectional studies of children and adolescents.

What next?

Future research should focus on developing, implementing, and evaluating interventions that disentangle the co-occurrence of unhealthy behaviours among youth. These interventions should consider sociodemographic factors and address underlying psychosocial and environmental factors. Successful strategies could inform evidence-based policies and practices to reduce health risks associated with these health behaviour clusters.

Citation details

Alosaimi N, Sherar LB, Griffiths P, Pearson N. Clustering of diet, physical activity and sedentary behaviour and related physical and mental health outcomes: a systematic review. BMC Public Health. 2023. DOI: 10.1186/s12889-023-16372-6